Emergent Surgery Does Not Independently Predict 30-Day Mortality After Paraesophageal Hernia Repair: Results from the ACS NSQIP Database

Toms Augustin, Eric Schneider, Diya Alaedeen, Matthew Kroh, Ali Aminian, David Reznick, Matthew Walsh, Stacy Brethauer

Research output: Contribution to journalArticle

Abstract

Aim: Patients undergoing emergency surgery for paraesophageal hernia (PEH) repair have a higher adjusted mortality risk based on Nationwide Inpatient Sample (NIS). We sought to examine this relationship in the National Surgical Quality Improvement Program (NSQIP), which adjusts for patient-level risk factors, including factors contributing to patient frailty. Methods: This is a retrospective analysis of the NSQIP from 2009 through 2011. A modified frailty index was created based on previously validated methodology. Results: Of 3498 patients with PEH repair, 175 (5 %) underwent emergent surgery. Older age, lower BMI, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), current dialysis, SIRS, and sepsis were significantly more common among emergent patients. These patients also had a poorer functional status, higher American Society of Anesthesiologists (ASA), and higher frailty scores and more likely to undergo open surgery. Postoperative complications were proportionally more common, and LOS was longer (8.5 vs. 3.4 days) among emergent patients (all p <0.05). In univariate analysis, emergent patients demonstrated ten times greater mortality than the elective surgery group (8 vs. 0.8 %). On adjusted analysis, emergent surgery was no longer independently associated with mortality. Frailty score 2 or above and preoperative sepsis significantly predicted increased mortality while laparoscopic repair and BMI 25–50 and BMI ≥30 (vs. BMI

Original languageEnglish (US)
Pages (from-to)2097-2104
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume19
Issue number12
DOIs
StatePublished - Dec 1 2015

Keywords

  • Elective surgery
  • Emergency surgery
  • Laparoscopy
  • Mortality
  • NSQIP
  • Paraesophageal hernia repair

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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